The purpose of this essay is to compile a list of symptoms to aid voice teachers in the early detection of vocal problems resulting from bulimic behavior. Bulimia nervosa (BN) is an eating disorder characterized by bingeing and purging and has a high rate of occurrence among the college population. Entertainers form a high risk group for development of BN yet the effects of BN on the voice are largely ignored in vocal literature. The study begins with a literature review which links several factors that can influence the development of BN with "the singer’s personality." The two main character traits that appear most frequently are perfectionism and anxiety. The study continues with a narrative presentation of interviews by the author with three voice specialists in different fields of voice research and treatment. The research questions on which the interview portion of the study were based are: 1) Are otolaryngologists seeing an increase in vocal problems associated with eating disorders?; 2) Is there a belief among voice specialists that singer-actors are a high risk group for the development of eating disorders?; 3) What vocal symptoms should voice teachers watch and listen for if they suspect a student is bulimic?; 4) How should the voice teacher approach the recommendation of treatment, care, and use of the bulimic voice? This portion of the paper includes a clear and concise list of symptoms associated with BN that are easily identifiable by sight or sound. The paper concludes with a summary of the study results, suggestions for voice teachers training singers with the disorder, and ideas for further research.

published_or_final_version / Surgery / Master / Master of Medical Sciences

Adductor spasmodic dysphonia (ADSD) is a focal dystonia that is characterized by voice breaks due to involuntary contractions of the adductor muscles of the vocal folds. These spasms can interfere with the coordination and balance of the respiratory and phonatory systems interfering with normal voice production. Disruptions in normal respiratory behaviors are well documented in inviduals with laryngeal disorders, including ADSD. Previous research regarding respiratory processes in ADSD has focused on airflow and pressure; however, there are many other parameters that have not been considered and may shed new light on the respiratory behaviors of individuals with ADSD. Therefore, the current pilot study attempted to determine if individuals with ADSD differed from controls in various breathing parameters while engaged in conversational and reading tasks.Thirty individuals were tested; fifteen in the ADSD group and fifteen in the age- and gender-matched control group. Respitrace, an inductive plethysmography device, calculated 14 different respiratory measures related to volume, timing, thoracic displacement and respiratory efficiency. The results of the study indicated that various significant differences existed between groups. Those with ADSD were found to have statistically higher ventilation rates, a greater frequency of breaths per minute, a higher degree of muscular inefficiency/breathlessness and labored breathing. These results indicated that individuals with ADSD suffered from disordered breathing due to the neurologically related obstruction at the level of the larynx. Differences according to task were also found. Specifically, the rib cage contributed to a lesser extent in voice production and the participants utilized longer inspiratory times, exhaled a larger volume of air and took longer to reach peak expiratory flow during conversational tasks when compared to reading tasks. These differences were attributed to a higher cognitive-linguistic demand required during conversational speech. Overall, the results of this study have many clinical implications. Most importantly, these findings support the idea that individuals with ADSD may experience difficulties with respiration as the effects of their Botox injection begin to wear off. Further research is needed with regards to the effects laryngeal spasms have on other respiratory behaviors.

Bakgrund Kraven på evidensbaserad vård ökar ständigt. Att jämföra patienters självskattade besvär före och efter behandling är ett sätt att utvärdera behandlingseffekten.  Rösthandikappindex (RHI) och VA-skala för röstbesvär är två verktyg för utvärdering av röstbehandling. Tidigare studier har visat att röstbehandling ger minskade självskattade röstbesvär. Syfte Syftet med denna studie var att med självskattningsformulär utvärdera effekten av logopedisk röstbehandling i Västerbottens läns landsting (VLL) och undersöka om behandlingseffekten påverkas av kön, diagnos, antal behandlingstillfällen och hur mycket tid patienten är beredd att lägga på behandling, samt att undersöka om det finns ett samband mellan självskattningsformuläret RHI och VA-skala för röstbesvär. Metod 102 patienter, 28 män och 74 kvinnor, som under perioden januari 2009 till september 2012 genomgått logopedisk röstbehandling inom VLL, deltog i studien. Deltagarna rekryterades retrospektivt. Genom dataanalys undersöktes huruvida det fanns någon signifikant skillnad i poäng på RHI efter behandling, om det fanns några signifikanta skillnader i självskattning beroende på kön, diagnos eller antal behandlingstillfällen samt om det fanns en korrelation mellan RHI-poäng och skattning på VA-skala. Resultat En signifikant minskning av RHI-poäng kunde ses för hela gruppen efter röstbehandling jämfört med före. Inga signifikanta skillnader sågs mellan könen eller mellan grupper indelade utifrån antal behandlingstillfällen. Det fanns inte heller någon skillnad mellan olika diagnoser. Däremot sågs signifikanta korrelationer mellan RHI och VA-skala för röstbesvär. Slutsats Studien visade att de självskattade besvären minskade efter behandling. Resultaten var inte beroende av kön, diagnos eller antal behandlingstillfällen. Utifrån detta dras slutsatsen att den logopediska röstbehandlingen i Västerbottens läns landsting ger effekt. Vad gäller de självskattningsverktyg som används i verksamheten sågs en korrelation mellan RHI och VA-skala för röstbesvär. Det är möjligt att dessa verktyg mäter olika aspekter av samma problem. Det är då av vikt att kombinera dessa för att få en helhetsbild av patienters upplevda röstbesvär / Background The demand for evidence based health care is increasing. One way to evaluate the effect of treatment is to compare patients’ self-assessed malaise before and after treatment. Two useful tools for evaluating voice therapy administered by a speech-language pathologist  is Voice Handicap Index (VHI) and a Visual Analogue Scale, VA-scale, for voice problems. Previous studies has found that voice therapy results in a decreased level of voice problems                                                                                        Aim The aim of this study was to evaluate the effect of voice treatment administered by speech-language pathologists in Västerbottens läns landsting (VLL) with help of the self-assessment tools VHI and VA-scale for voice problems and to investigate if there were any differences in the self-assessment due to gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The aim was also to investigate if there was a correlation between the VHI and the VA-scale for voice problems.                                                                                                                      Method This retrospective study has analyzed self-assessment forms from 102 patients, 28 men and 74 women, who have been seeing a speech-language pathologist for voice therapy sometime between January 2009 and September 2012 in VLL. Data analysis was used to investigate if there was any significant difference in VHI points before and after voice therapy, if there was any significant differences in the self-assessment due to gender, diagnosis or number of therapy sessions and if there was a correlation between the points on VHI and self-assessed malaise on the VA-scale for voice problems.                                                                                                                      Results There was a significant decrease of VHI points for the whole group after voice therapy. No significant differences were found regarding gender, diagnosis or number of treatment sessions. There was no correlation between the VHI score and the amount of time the patient was willing to spend on voice therapy. A significant correlation was found between VHI and the VA-scale for voice problems.           Conclusion This study found that self-assessed voice problems decreased after voice treatment. The efficacy of voice therapy does not seem to be affected by gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The conclusion is that the voice therapy administered by speech-language pathologists in VLL has an effect. There was a correlation between VHI and the VA-scale for voice disorders. It is possible that these tools are measuring different aspects of the same problem. Therefore, it is important to combine these tools to get an overall picture of the patients’ self-perceived voice problems.

The purpose of this study was to identify the perceptions of voice teachers regarding the degree to which they believe they teach and monitor healthy vocal behaviors among their students as they sing and speak. Participants for the study were college/university voice professors who were members of the College Music Society and listed in its Directory of Music Faculties in Colleges and Universities, U.S. and Canada, 2012-2013 Edition. Online, survey research procedures and a researcher-generated questionnaire were utilized for data collection purposes. Results indicated that an overwhelming majority of participants believed there to be a relationship between the health of one’s singing voice and the health of one’s speaking voice. Participants’ perception scores were the most positive for variable MBSi, or the degree to which they believe they monitor the vocal behaviors of students when singing. Participants’ perception scores for variable TVB, the degree to which they believe they teach healthy vocal behaviors to students, and variable MBSp, the degree to which they believe they monitor the vocal behaviors of students when speaking, ranked second and third respectively. Perception scores for variable TVB were primarily associated with participants’ familiarity with vocal rehabilitation techniques, gender, and participants’ familiarity with the McClosky Technique. Perception scores for variable MBSi were primarily associated with participants’ familiarity with vocal rehabilitation techniques, gender, type of student taught, and whether participants had instructed a student with a vocal disorder. Perception scores for variable MBSp were correlated with the greatest number of characteristics, including participants’ familiarity with vocal rehabilitation techniques, participants’ familiarity with the McClosky Technique, type of student taught, years of teaching experience, and whether participants had instructed a student with a vocal disorder. The researcher concluded that, while many voice teachers understand the relationship between the health of the speaking voice and the health of the singing voice and use various methods within their private studios to work with injured voices, voice teachers and students may not understand, nor be adequately prepared to prevent and intervene when it comes to issues of the speaking voice. In fact, the researcher concluded that there seems to be a disconnect among teachers and students alike when it comes to teaching and understanding healthy vocal behaviors and applying them to the speaking voice. Multiple resources exist, however, in the form of various certifications, symposiums, and workshops, through which voice teachers may avail themselves of the knowledge necessary to care for the overall health of their students’ speaking and singing voices. Indeed, the voice teacher is obligated to teach well-rounded, healthy vocal behaviors, applying them to both the singing voice and the speaking voice. As medical professionals more frequently reach out to voice teachers, voice teachers will have increased opportunity to assume a more active role on a voice care team. Because so many teachers already implement methods found within the McClosky Technique, if used with understanding and commitment, the Technique could be a means for habilitation, prevention, and intervention on behalf of students suffering from speaking voice disorders within the voice studio. / Access to thesis permanently restricted to Ball State community only. / School of Music

Made available in DSpace on 2014-08-13T14:50:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-08-08Bitstream added on 2014-08-13T18:00:35Z : No. of bitstreams: 1 000758071.pdf: 2167961 bytes, checksum: 9d3f894a2590620cac068aa44611057e (MD5) / Nódulos vocais são as principais causas de disfonias infantis. As análises vocais perceptivo-auditivas e acústicas têm sido utilizadas para diferenciar as vozes de crianças com nódulos, de vozes normais. Determinar os parâmetros vocais perceptivo-auditivos e acústicos em crianças de quatro a 11 anos com diagnóstico de nódulos vocais. Realizado estudo comparativo que incluiu 100 crianças de quatro a 11 anos, com diagnóstico videolaringoscópico de nódulos vocais (grupo nódulos-GN) e 100 crianças da mesma faixa etária, sem sintomas vocais e com exames de videolaringoscopia normais (grupo controle-GC). Todas foram submetidas às análises vocais perceptivo-auditivas (escala GRBASI), ao cálculo do Tempo Máximo de Fonação e da relação s/z e à análise vocal acústica (programa MDVP). Crianças com nódulos vocais (GN) apresentaram valores menores do TMF, especialmente para os fonemas /z/ e /a/ (p<0,05). O TMF aumentou com a idade em ambos os grupos e a relação /s/z não se deferiu. As avaliações perceptivoauditivas indicaram maior comprometimento nas crianças do grupo nódulos do que do controle, nos parâmetros: G (79 versus 24), R (53 versus 3), B (67 versus 23) e Strain (35 versus 1). As medidas acústicas Jitter, Pich Perturbation Quotient (PPQ), Shimmer, Amplitude Perturbation Quotient (APQ), Noise Harmonic Ratio (NHR) e Soft Phonation Index (SPI) mostraram-se mais elevados no grupo nódulos. O parâmetro f0 não diferiu entre os grupos. Os parâmetros vocais Tempo Máximo de Fonação (TMF), perceptivoauditivos (GRBS) e acústicos (Jitter, PPQ, Shimmer, APQ, NHR e SPI) mostraram-se mais comprometidos nas crianças com nódulos, sendo importantes métodos de avaliação nas disfonias infantis. Os valores de f0 não se diferiram entre os grupos / Vocal nodules constitute the major causes of dysphonia during childhood. Auditoryperceptual and acoustic vocal analyses have been used to differentiate voice with nodules from normal voice in children. To study the value of auditory-perceptual and acoustic vocal analyses in assessments of children with nodules. A comparative study was carried out including 100 children aged between 4 and 11 years, with videolaryngoscopic diagnosis of vocal nodules (nodule group), and 100 children within the same age range, without vocal symptoms and with normal videolaryngoscopic exams (control group). All children were subjected to auditory-perceptual vocal analyses (GRBASI scale), calculation of Maximum Phonation Time and s/z ratio, and acoustic vocal analysis (MDVP software). There was no difference in the values of maximum phonation time and s/z ratio between groups. Auditory-perceptual analysis indicated greater compromising of voice parameters for the nodule than for the control group: G (79 versus 24), R (53 versus 3), B (67 versus 23) and S (35 versus 1). The acoustic parameters jitter, PPQ, shimmer, APQ, NHR and SPI showed higher values in the nodule than in the control group. The parameter f0 did not differ between groups. Auditory-perceptual (G, R, B and S) and acoustic vocal parameters (jitter, PPQ, shimmer, APQ, NHR and SPI) were more compromised for children with nodules than for those of the control group, constituting important methods for assessing child dysphonia

Made available in DSpace on 2015-07-22T20:49:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-18 / Objetivo:Identificar quais as características discriminatórias do diagrama de desvio fonatório em vozes predominantemente adaptadas, rugosas,soprosas e tensas,em indivíduos adultos.Método:Foram analisadas 196 amostras vocais da vogal /ε/ sustentada de indivíduos adultos, divididas em dois grupos, 163 com alteração vocal e 33 sem alteração vocal.As amostras foram submetidas a dois tipos de avaliação,a perceptivo-auditiva e a acústica.A avaliação perceptivo-auditiva concentrou-se na identificação do tipo de predominância da qualidade vocal–adaptada,rugosa,soprosa ou tensa,e no grau de alteração da qualidade alterada,por meio da escala analógico-visual e sua correspondência numérica.A análise acústica do sinal vocal foi realizada no programa VoxMetria(CTS Informática)e abrangeu a configuração da distribuição das amostras vocais no diagrama de desvio fonatório quanto à área de normalidade,densidade, forma e localização nos quadrantes,e a extração de medidas acústicas como frequência fundamental,jitter,shimmer,correlação e GNE.Resultados: Houve diferença significante na localização das amostras vocais em relação à área de normalidade do diagrama, sendo que 100 por cento(33)das vozes adaptadas encontraram-se dentro da área e 69,3 por cento(113)das alteradas fora dela(p<0,001).Vozes adaptadas apresentaram densidade concentrada(78,8 por cento, 26)com diferença significante das vozes alteradas (p<0,001),que apresentaram densidade ampliada(56,4 por cento, 92).Em relação ao tipo de voz,todas as vozes adaptadas localizaram-se no quadrante inferior esquerdo, 45 por cento(27)das rugosas no quadrante inferior direito, 52,6 por cento(30)das soprosas no superior direito e 54,3 por cento(25)das tensas no inferior esquerdo.Quanto ao grau de alteração vocal, das 16 vozes alteradas avaliadas com grau 1, 93,8 por cento(15)localizaram-se no quadrante inferior esquerdo.As vozes classificadas com grau 3 de alteração dividiram-se entre os quadrantes inferior e superior direitos.Dos desvios vocais intensos,80 por cento(8)localizaram-se no quadrante superior direito.O quadrante inferior esquerdo concentrou vozes avaliadas na escala analógico-visual até 35,5mm(grau 1)e algumas de 35,5 a 50,5mm(grau 2).As vozes com grau 3 de alteração distribuíram-se nos quadrantes inferior direito,superior esquerdo e superior direito,sendo que neste localizaram-se as vozes com pior grau de alteração.Os valores de jitter e shimmer diferenciaram as vozes tensas das rugosas(p<0,021 e p=0,0032; respectivamente)e das soprosas (p=0,021 e p=0,005,respectivamente).O GNE também diferenciou as vozes tensas das rugosas(p=0,003)e das soprosas(p<0,002),além de diferenciar vozes rugosas e soprosas(p<0,001).A correlação entre F0 e os demais parâmetros acústicos não foi significante e a qualidade da correlação foi péssima:jitter(p=0,257; -8,9 por cento),shimmer (p=0,158; -11,2 por cento),correlação(p=0,285; 8,4 por cento) e GNE(p=0,790; -2,1 por cento).Conclusões:O diagrama de desvio fonatório diferenciou vozes adaptadas e vozes alteradas.Vozes adaptadas localizaram-se dentro da área de normalidade e,a maioria das vozes alteradas, fora.Não houve relação entre tipo de voz, densidade e forma no diagrama.A distribuição das vozes nos quadrantes relacionou-se com o tipo e o grau da alteração da voz.O GNE foi o único parâmetro acústico capaz de diferenciar os três tipos de vozes alteradas. / Purpose: To identify which characteristics discriminates the hoarseness diagram of adult voices that are predominantly adapted, rough, breathy and strained. Method: 196 adult voice samples of the sustained vowel “ae” were analyzed. They were distributed into two groups, 163 with vocal deviation and 33 with healthy voices. Voice samples were submitted to two types of analyses: acoustic and auditory perceptual. The perceptual analyses focused on the identification of the vocal quality predominance – adapted, rough, breathy and strained and also in the degree of deviation, by using a visual analogue scale and its numeric correspondence. The acoustic analyses was performed by means of the VoxMetria software (CTS Informatica) and consisted of assessing the configuration of vocal sample distribution in the hoarseness diagram according to normality area, density, shape and location in the quadrants, and the extraction of fundamental frequency, jitter, shimmer, correlation and GNE. Results: There was a significant difference in the position of the voice samples in relation to the normality area of the diagram, meaning that 100% (33) of the adapted voices were located inside this area and 69.3% (113) of the deviated voices were outside it (p<0.001). Adapted voices presented concentrated density (78.8%, 26), which were statistically different from the deviated voices (56.4%, 92) that presented spread density (56.4%, 92). As far as voice type is concerned, all adapted voices were located at the inferior left quadrant, 45% (27) of the rough voices were at the inferior right, 52.6% (30) of the breathy voices were at the superior right and 54.3% (25) of the strained were at the inferior left. Concerning the degree of severity of vocal deviation, 93.8% of the 16 deviated voices evaluated as having a 1 degree of deviation were located at the inferior and superior right quadrants. In the other hand, 80 % (8) of the voice with a severe degree of deviation were located in the superior right quadrant. The inferior left quadrant concentrated the voices evaluated by the visual analogue scale up to 35.5mm (degree 1) and some from 35.5 to 50.5mm (degree 2). Voices with 3 degree of deviation were located in the inferior right Abstract and both superior left and right quadrants. The voices with the worse degree of deviation were located at the superior right quadrant. Jitter and shimmer differed the strained voices from the rough voices (p<0.021 e p=0.0032 respectively) and from the breathy voices (p=0.021 e p=0.005, respectively). The GNE did also differ the strained voices from the rough voices (p=0.003) and from the breathy voices (p<0.002).It also differentiated the rough from the breathy voices (p<0.001). The correlation between F0 and the other acoustic parameters was not significant and the quality of correlation was very poor: jitter (p=0.257; -8.9%), shimmer (p=0.158; -11.2%), correlation (p=0.285; 8.4%) and GNE (p=0.790; -2.1%). Conclusions: The hoarseness diagram differentiated the adapted from the deviated voices. Adapted voices were located in the normality area, and the majority of the deviated voices were outside it. There was not a relationship between type of voice, density and shape of configuration of vocal sample distribution in the diagram. The distribution of voices in the quadrants related to the type and degree of severity of voice deviation. GNE was the only acoustic parameter able to differ from the three types of deviated voices. / TEDE / BV UNIFESP: Teses e dissertações

Obtaining measurements of Maximum Phonation Time (MPT) and Vital Capacity (VC) are fundamental in a speech-therapy evaluation since they provide information about neuromuscular and aerodynamic control of a subject s vocal production. Such variables may be altered in subjects who have vocal nodules, a pathology which alters the glottic closure and the pneumo-phono-articulatory coordination. Aim: verify the MPT of vowels, the VC and the possible relationship between them in adult women with vocal nodules. Materials and Methods: database records from a speech therapy school-clinic were used, making up a total of 38 subjects. The inclusion criteria were female adults and otorhinolaryngology diagnosis of vocal nodules. The exclusion criteria were: to have another laryngeal pathology other than the vocal nodules; hearing loss; oral breathing; history of neurological, psychiatric, endocrine or gastric disorders; flu or allergy history; drinking and/or smoking habits; previous speech therapy and/or otorhinolaryngology treatments. Anamnesis data, the otorhinolaryngology diagnosis, and the MPT measurements of vowels /a, i, u/ were collected from the database, as well as the value of the highest vital capacity from all subjects in the sample. MPT evaluation is given by the duration measurement of three emissions of each vowel. The patient is asked to stand and produce such sounds in habitual tone and intensity until the end of exhalation. The highest value of each vowel is then considered. Regarding VC values, the patient is asked to perform six exhalations in the spirometer, after maximal inhalation. Three exhalations are performed with nasal occlusion and three without occlusion, including a rest between them. Finally, the highest out of the six values collected is considered. The results were statiscally analysed at a 5% significance level. The analysis was carried out through descriptive statistics, Mann-Whitney U Test, Variables Normality Tests (Lilliefors), Spearman Correlation, Kruskal-Wallis Test. Results: representative age range; representative and within normality VC; less homogeneous MPT and mean, below normality and with a strong positive and meaningful correlation; moderate, positive and meaningful correlation between VC and MPT and the mean. Conclusion: in the presence of vocal nodules in an adult group of women, the Maximum Phonation Times were reduced, the vowel /a/ presented a lower value when compared to the other vowels, and the VC remained within normality, having a moderately positive correlation between both of them. / A obtenção de medidas de Tempos Máximos de Fonação (TMF) e da Capacidade Vital (CV) são fundamentais na avaliação fonoaudiológica, pois revelam informações sobre o controle neuromuscular e aerodinâmico da produção vocal de um indivíduo. Tais variáveis podem estar alteradas em indivíduos com nódulos vocais, patologia que altera o fechamento glótico e a coordenação pneumofonoarticulatória. Objetivo: verificar os TMF de vogais, a CV e a relação entre ambos em mulheres adultas com presença de nódulos vocais. Materiais e Métodos: utilizaram-se os registros do Banco de dados de uma clínica-escola de Fonoaudiologia, totalizando um grupo de estudo constituído de 38 sujeitos. Os critérios de inclusão foram: adultos do sexo feminino e diagnóstico otorrinolaringológico de nódulos vocais. Os critérios de exclusão foram: apresentar outra patologia laríngea além dos nódulos vocais; comprometimento auditivo; respiração oral; histórico de doenças neurológicas, psiquiátricas, endocrinológicas ou gástricas; gripe ou quadros de alergias; hábitos de etilismo e/ou tabagismo; tratamento fonoaudiológico e/ou otorrinolaringológico prévios. Foram coletados do Banco de Dados os dados de anamnese, o diagnóstico otorrinolaringológico, e as medidas de TMF das vogais /a, i, u/, bem como o valor da maior CV de todos os sujeitos da amostra. A avaliação dos TMF se dá pela medida da duração de três emissões de cada uma das vogais, sendo que o paciente é orientado a ficar em pé e realizar tais emissões em tom e intensidade habituais, até o final da expiração, considerando-se o maior valor de cada vogal. Em relação aos valores de CV, o paciente é solicitado a realizar um total de seis expirações no espirômetro, após inspiração máxima, sendo três delas com presença de oclusão nasal e três sem oclusão, com descanso entre elas. Por fim, é considerado o maior dos seis valores coletados. Os resultados foram analisados estatisticamente ao nível de significância de 5%, sendo a análise realizada por meio da estatística descritiva, Teste U de Mann-Whitney, Teste de Normalidade das Variáveis (Lilliefords), Correlação de Spearman, Teste de Kruskal-Wallis. Resultados: faixa de idade homogênea; CV representativa e dentro da normalidade; TMF e média menos representativos, abaixo da normalidade e com forte correlação positiva e significativa entre si; correlação moderada, positiva e significativa entre CV e TMF e sua média. Conclusão: na presença de nódulos vocais em um grupo de mulheres adultas, os TMF encontraram-se reduzidos, a vogal /a/ apresentou menor valor quando comparada às demais vogais, e a CV permaneceu dentro da normalidade, havendo correlação moderadamente positiva entre ambos.

Orientador: Regina Helena Garcia Martins / Resumo: Nódulos vocais são as principais causas de disfonias infantis. As análises vocais perceptivo-auditivas e acústicas têm sido utilizadas para diferenciar as vozes de crianças com nódulos, de vozes normais. Determinar os parâmetros vocais perceptivo-auditivos e acústicos em crianças de quatro a 11 anos com diagnóstico de nódulos vocais. Realizado estudo comparativo que incluiu 100 crianças de quatro a 11 anos, com diagnóstico videolaringoscópico de nódulos vocais (grupo nódulos-GN) e 100 crianças da mesma faixa etária, sem sintomas vocais e com exames de videolaringoscopia normais (grupo controle-GC). Todas foram submetidas às análises vocais perceptivo-auditivas (escala GRBASI), ao cálculo do Tempo Máximo de Fonação e da relação s/z e à análise vocal acústica (programa MDVP). Crianças com nódulos vocais (GN) apresentaram valores menores do TMF, especialmente para os fonemas /z/ e /a/ (p<0,05). O TMF aumentou com a idade em ambos os grupos e a relação /s/z não se deferiu. As avaliações perceptivoauditivas indicaram maior comprometimento nas crianças do grupo nódulos do que do controle, nos parâmetros: G (79 versus 24), R (53 versus 3), B (67 versus 23) e Strain (35 versus 1). As medidas acústicas Jitter, Pich Perturbation Quotient (PPQ), Shimmer, Amplitude Perturbation Quotient (APQ), Noise Harmonic Ratio (NHR) e Soft Phonation Index (SPI) mostraram-se mais elevados no grupo nódulos. O parâmetro f0 não diferiu entre os grupos. Os parâmetros vocais Tempo Máximo de Fonação (TMF), perceptivoauditivos (GRBS) e acústicos (Jitter, PPQ, Shimmer, APQ, NHR e SPI) mostraram-se mais comprometidos nas crianças com nódulos, sendo importantes métodos de avaliação nas disfonias infantis. Os valores de f0 não se diferiram entre os grupos / Abstract: Vocal nodules constitute the major causes of dysphonia during childhood. Auditoryperceptual and acoustic vocal analyses have been used to differentiate voice with nodules from normal voice in children. To study the value of auditory-perceptual and acoustic vocal analyses in assessments of children with nodules. A comparative study was carried out including 100 children aged between 4 and 11 years, with videolaryngoscopic diagnosis of vocal nodules (nodule group), and 100 children within the same age range, without vocal symptoms and with normal videolaryngoscopic exams (control group). All children were subjected to auditory-perceptual vocal analyses (GRBASI scale), calculation of Maximum Phonation Time and s/z ratio, and acoustic vocal analysis (MDVP software). There was no difference in the values of maximum phonation time and s/z ratio between groups. Auditory-perceptual analysis indicated greater compromising of voice parameters for the nodule than for the control group: G (79 versus 24), R (53 versus 3), B (67 versus 23) and S (35 versus 1). The acoustic parameters jitter, PPQ, shimmer, APQ, NHR and SPI showed higher values in the nodule than in the control group. The parameter f0 did not differ between groups. Auditory-perceptual (G, R, B and S) and acoustic vocal parameters (jitter, PPQ, shimmer, APQ, NHR and SPI) were more compromised for children with nodules than for those of the control group, constituting important methods for assessing child dysphonia / Mestre

A obesidade é uma endemia, com prevalência estimada, entre os anos de 1989 e 1994, de quase 40% na população norte-americana e 20% na população brasileira, que traz diversos problemas de saúde no seu contexto biopsicossocial. Dentre essas comorbidades discute-se a característica da voz destes indivíduos. O objetivo deste estudo foi caracterizar os parâmetros vocais dos indivíduos portadores de obesidade mórbida, comparado-os aos de indivíduos não obesos, através da análise acústica e perceptivo-auditiva no sentido de caracterizar seu padrão vocal. Método: Foram selecionados 45 indivíduos adultos voluntários do Ambulatório de Obesidade da Disciplina de Cirurgia do Aparelho Digestivo, de ambos os sexos com IMC acima de 35 Kg/m2. Para cada indivíduo do grupo em estudo, foi selecionado também um individuo adulto voluntário, pareado por sexo, idade e tabagismo, porém com IMC abaixo de 30 Kg/m2. Todos os indivíduos foram submetidos a exame laringológico e à gravação da voz no Setor de Fonoaudiologia do Ambulatório de Otorrinolaringologia. Foi realizada análise estatística onde os valores de p menores que 0,05 foram considerados estatisticamente significantes. Os resultados mostraram que os indivíduos portadores de obesidade mórbida apresentaram mais frequentemente: sinais laríngeos sugestivos de lesão por RGE; 4 vezes mais rouquidão, 3 vezes mais instabilidade, 5 vezes mais soprosidade; 5 vezes mais estrangulamento aos finais das emissões; Jitter, Shimmer e Ruído alterados e Tempos Máximos Fonatórios inferiores em relação aos indivíduos do grupo controle. Concluiu-se que o indivíduo portador de obesidade mórbida tem sua voz caracterizada como: rouca, soprosa e com instabilidade fonatória, com Jitter e Shimmer alterados, TMF diminuídos e com presença de estrangulamento da voz ao final das emissões. / Obesity is an endemic illness whose estimated prevalence, from 1989 to 1994, was 40% amongst North American people and 20% amongst Brazilian people. It is a disease that causes several health problems on a biopsychosocial basis. Amongst these consequences of obesity, the voice characteristics of affected people is a target of discussion and analysis. The purpose of this study was to set the voice patterns of people affected by morbid obesity, by making a comparison to the voice patterns of people who are not fat. The comparison was made through the acoustic and auditory-perceptive analysis in order to establish the voice patterns. Method: We have selected 45 adults who are volunteers coming from the Center for Obesity Specialized in the Digestive System Surgery. The selected people were men and women whose Body Mass Index (BMI) is higher than 35 kg/ m2. For each person selected, there is another one, also adult, same sex, age and smoking habit, but with a BMI under than 30 kg/ m2. All the volunteers made laryngology test and their voice was recorded in the Phonoaudiology Department, from the Center of Otorhinolaryngology. We prepared the statistics, disregarding the values under 0.05, considered statistically insignificant. The results showed that the patients affected by morbid obesity presented more frequently: signs on their larynx that indicate gastroesophageal reflux (GER); 4 (four) times more hoarseness, 3 (three) times more instability, 5 (five) times more vocal fatigue and breathing; 5 (five) times more voice cracking. Besides these disabilities, people affected by morbid obesity presented changes in Jitter, Shimmer and Noise, as well as low Maximum Phonation Time (MPT). We conclude that people affected by morbid obesity present roughness, breathness with phonatory instability, changes in Jitter and Shimmer, low MPT and cracking voice